Provider Demographics
NPI:1881688166
Name:REMSEN, KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:REMSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 STATE RT 23
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1625
Mailing Address - Country:US
Mailing Address - Phone:973-831-1220
Mailing Address - Fax:973-831-0029
Practice Address - Street 1:51 STATE RT 23
Practice Address - Street 2:FLOOR 2
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1625
Practice Address - Country:US
Practice Address - Phone:973-831-1220
Practice Address - Fax:973-831-0029
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA43991207YS0123X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223603690OtherTIN
NJ223603690OtherTIN
NJC59830Medicare UPIN